Healthcare Provider Details

I. General information

NPI: 1619211067
Provider Name (Legal Business Name): STARLIGHT ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2012
Last Update Date: 11/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 CHADDICK DR
WHEELING IL
60090-6450
US

IV. Provider business mailing address

818 CHADDICK DR
WHEELING IL
60090-6450
US

V. Phone/Fax

Practice location:
  • Phone: 847-229-0001
  • Fax:
Mailing address:
  • Phone: 847-229-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS1112003
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADS1113003
License Number StateIL

VIII. Authorized Official

Name: ERNST BERLIN
Title or Position: CO-OWNER
Credential:
Phone: 847-673-6633